Bipolar I Disorder (Type 1)

What is Bipolar I Disorder?

Bipolar I disorder (type 1) is a chronic mood disorder which causes individuals to experience extreme high and low moods, known as manic episodes and major depressive episodes.

The condition is frequently confused with bipolar II disorder which, although it shares some symptoms, does not cause as extreme episodes of mania. Although there is no definitive cure, bipolar I can be successfully managed with a combination of medication, psychotherapy and lifestyle changes.

Overview of Bipolar I disorder

Individuals with Bipolar I disorder experience dramatic swings in mood. In order for a diagnosis to be made, an individual must have experienced at least one manic episode and one episode of major depression.

A manic episode is a period in which an individual’s mood is extremely elevated, to the point that they may feel out of control. During mania, sufferers may experience psychosis and delusional thoughts, and they may feel as though they need very little or even no sleep at all.

They may experience racing thoughts and feel highly creative and motivated, which can lead them to make decisions which could cause problems. For example, it’s not uncommon for people with bipolar I disorder to spend far more than they can afford during a manic episode, or to make grandiose plans that they cannot follow through with. Mania can also often cause irritability and anger, and cause sufferers to lash out at those around them.

The manic episodes experienced with Bipolar I are interspersed with episodes of major depression. Major depression causes extreme low moods and can make individuals feel persistent negative emotions, lack of interest in things that would usually give them pleasure, and low energy and motivation. Individuals may feel so low that they have thoughts of harming themselves or experience suicidal ideation, which causes them to have thoughts of how to kill themselves.

Episodes of both mania and major depression can last anywhere between a few days and several years at a time, although they usually last for a few weeks at a time. Individuals may cycle directly from a manic episode into a depressive episode, or there may be several weeks in between the extreme moods during which time they may feel relatively stable.

Symptoms of Bipolar I Disorder

There are many symptoms associated with Bipolar I, and the way in which the condition presents itself can differ greatly from one person to the next. Since the condition is characterized by extreme high and low moods, it’s important to look out for symptoms of mania and depression separately.

Symptoms of mania include:

  • Racing, jumbled thoughts
  • Trouble focusing and getting distracted easily
  • Extreme euphoria and excitability
  • Feeling invincible or as though you have special powers or knowledge that others don’t
  • Paranoia and delusions
  • Psychosis – hearing or seeing things that others don’t
  • Making rash decisions which could be risky, dangerous or detrimental to your well-being in future
  • Insomnia or sleeping very little
  • Spending money inappropriately or to excess
  • Loss of social inhibitions and acting or speaking inappropriately to others
  • Increased sex drive
  • Lack of awareness that your behavior is unusual or reckless.

Symptoms of major depression include:

  • Unusually low energy and extreme fatigue
  • Lack of motivation and focus
  • Inability to enjoy activities that would usually be enjoyed
  • Feelings of worthlessness, helplessness or guilt
  • Inability to concentrate, remember things or make decisions
  • Overeating or loss of appetite
  • Unusual sleeping patterns, such as sleeping too little or too much
  • Persistent sense of sadness, pessimism or emptiness
  • Thoughts or attempts of suicide and self-harm
  • Reduced sex drive
  • Physical aches, pains, headaches or digestive issues
  • Irritability and restlessness

In order for Bipolar I to be diagnosed, an individual must have experienced at least one manic episode, but they may have also experienced episodes of hypomania too. Hypomania is an elevated state of mood which is less extreme than mania. Typically, individuals are aware of their elevated mood during hypomanic episodes and can control their behavior to a certain extent, whilst with mania, individuals usually cannot acknowledge that their behavior is unusual, dangerous or out of control.

Symptoms of hypomania include:

  • Euphoric mood
  • High energy
  • Racing thoughts
  • Feeling more sociable and confident
  • Increased creativity and ability to come up with ideas and plans
  • Heightened senses, such as seeing colors more vividly or hearing sounds more clearly
  • Agitation and finding it difficult to sit still
  • Sleeping little
  • Restlessness and finding it difficult to relax
  • Impatience, irritability or anger

Bipolar I Disorder Causes

It is thought that bipolar I disorder is caused by three factors; genetics, chemical imbalances, and environmental triggers.

Bipolar seems to run in families, and individuals who are being assessed by a doctor will often be asked about their family medical history in order to establish if a parent, grandparent or other relative suffered from the condition. Individuals who have a family with the condition are at an increased risk of developing it themselves, and should therefore keep a particularly close eye on their mental health. However, researchers have not been able to establish a single gene that is responsible for bipolar I, which suggests that other causes or triggers are involved.

It is understood that bipolar occurs as a result of physical, chemical imbalances in the brain. Chemicals such as noradrenaline, serotonin, and dopamine, known as neurotransmitters, are all found in the brain and are responsible for healthy brain function. For example, if the balance of the levels of these chemicals changes, it can cause bipolar symptoms. Excessive levels of noradrenaline typically occur during manic episodes, while low levels of the same chemical can cause depressive episodes.

While someone may be genetically at risk of developing the chemical imbalances which lead to bipolar disorder, they may not necessarily ever show symptoms of the condition in their life. It is believed that certain environmental factors can trigger the disorder. In some instances, this could be periods of extreme stress or emotional trauma, such as the death of a close family member or friend, the loss of a job and subsequent financial problems, or the breakdown of a relationship. Emotional, sexual or physical abuse are also typical stressful triggers. In other instances, physical illnesses can trigger bipolar I disorder, as can sleep disturbances such as a period of insomnia.

Treatments for Bipolar I Disorder

There is a wide range of treatments available for bipolar I disorder and many doctors will prescribe a combination of medication and psychotherapy in order to manage symptoms. There is no definitive cure for the condition, but many people are able to manage their symptoms successfully enough to enjoy a good quality of life.

Mood stabilizing medications are typically used to help reduce the severity of the extreme highs and lows that individuals with bipolar I face. Lithium is one such example of a mood stabilizer which can offer very effective results, but it can cause a range of side effects. Weight gain, acne, hand tremors, increased thirst and urination, hair loss and drowsiness are a few examples of common, minor side effects of lithium. Often, these can be managed with other drugs if they become problematic. In other instances, doctors may slightly adjust the dosage of the drug in order to minimize side effects while ensuring the drug remains an effective mood stabilizer.

Lithium tends to take a few weeks to start having an effect, which means it is best suited to long term use. It can help to reduce the severity of current episodes of mania or depression, as well as help to prevent future episodes. However, it has been known to cause problems with thyroid and kidney function, and doctors usually request regular blood tests in order to monitor this. It’s usually recommended to drink plenty of water when taking the drug, but since fluid intake can affect the lithium levels in the blood, it’s important to consume around the same amount of water each day.

Doctors may also prescribe medications to treat the symptoms of bipolar I disorder as and when they occur. For example, antipsychotic drugs may be used during a manic episode to alleviate psychosis, while antidepressants could be used during major depressive episodes.

Psychotherapy is another important treatment for bipolar I because it can help patients to find methods to cope with the condition in the long term as well as facilitate their recovery during episodes of mania or depression. Talking therapies can be incredibly helpful for dealing with depressive thoughts. They can also help individuals who are struggling to maintain relationships with friends or family members as a result of their illness. A psychotherapist or counselor may also help individuals to learn to recognize triggers or early signs of an episode in order that they can regain some control over the condition.

Simple lifestyle changes can often help to manage the severity of bipolar I disorder or minimize triggers or aggravating factors. For example, adopting good sleep hygiene habits, eating a well-balanced diet and doing regular exercise can all help to boost physical and mental health and reduce stress, which is a common trigger for manic or depressive episodes.

Often, individuals can benefit from sharing their experience of bipolar with others who suffer from the same condition. Doctors and psychotherapists may be able to recommend support organizations or charities which run self-help groups for this reason. There are also groups available for family members or spouses of individuals who have bipolar I disorder, and these serve as an opportunity to learn more about the condition and share advice on how to cope with a loved one who has the condition.

Bipolar I Disorder Prevention

Individuals who have a family member with bipolar I and are therefore at a greater risk of developing the condition may wish to seek advice from a doctor or psychologist in regards to preventing the condition. Since environmental factors can trigger the disorder, it may be helpful to find healthy coping mechanisms for stress and emotional trauma, such as frequent exercise, hobbies or relaxation techniques. It can be useful to learn more about early warning signs of bipolar in order that you can recognize episodes of depression or mania before they occur and seek early medical intervention where necessary.

Those who have already been diagnosed with bipolar I may be able to find methods to prevent further episodes of mania or depression. If they are already aware of factors that trigger episodes, they can strive to avoid them as much as possible. It’s also very helpful to adopt healthy sleep, diet and exercise routines in order to keep physical health in check and minimize the risk of physical or emotional stress which could trigger episodes.

It is also incredibly important that individuals follow the advice of their doctor in regards to medications. Long term medications such as mood stabilizers may seem redundant when an individual feels stable and well, but if they stop taking them without consulting their doctor it could result in a manic or depressive episode. Similarly, some medications can trigger depression or mania so it’s important to double check with your doctor before taking a new medication that it is safe to do so.

Last Reviewed:
September 25, 2017
Last Updated:
November 16, 2017
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